Photo Gallery
CASE OF THE WEEK
January 07, 2012 (SEE THE RESULTS OF MS. AIRIE TSUKADA AFTER 3 MONTHS)
I have operated on her last October 2011 and the results 3 weeks post-op where already published (see October 7 posting). After 3 months the nose looks more natural as if the person was born with it. No one can really tell that she had a surgery. The inblending of the gore-tex implant is the reason for its superior look.
I am an advocate on the use of gore-tex implant for the nasal bridge and septal cartilage for the nasal tip. There is a wrong notion that gore-tex implant can be used for the nasal tip. If you use it that way, the joints of the nose will be compromised as well.
GORE-TEX looks very natural when used for the nasal bridge. However for the nasal tip, nothing can beat the harvest of the SEPTUM which is a cartilage that separates your right and left nostril. It is strong and straight compared to the ear cartilage, thus allowing better elongation and tip definition.
Lastly we can use the ear cartilage for some tip contouring and refinements.
October 14, 2011 (STARTING IT YOUNG)
Facebook, Twitter, google search and other social networking sites are the great leverager in this modern times. I have noticed that people dont go anymore with MEDIA HYPED DOCTORS (MHD) but instead perform an in depth research on the surgeon before entrusting their beauty needs. MHD dont operate themselves but have hired surgeons that are often overworked to perform delicate surgery in your face. And you know what the result is when someone dwells on the quantity.
At Shimmian, we perform only 2 surgeries per day 1 in the morning and 1 in the afternoon all performed by yours truly to maintain the quality. I have been performing this for the past decade of my life and the great testimonials from patients that underwent surgery in our center keep the passion to deliver a well crafted nose in my clients.
Here is another case of a young patient with a short nose that looks old for her current age. After nasal elongation using her own septal cartilage and nasal dorsum augmentation with 5 mm gore-tex, her face becomes more softer and there is clear definition of beauty in the depthness and glow of her eyes.
PROFILE VIEW
October 07, 2011 (THE POWER OF YOUTH)
A lot of my clients have been asking me when is the best time to have a rhinoplasty? In my previous columns I already stated the importance of nasal cosmetic surgery however the big question still remains on when is the right time?
There are 2 growth spurts for the nose, one during the pre-pubescent stage and the other one right after adolescence. For the males the last surge of nasal development occurs from 16-17y.o. and for females its 14-15 y.o.. So there you go, another evidence of a late male development!
Now, are the age stated above the best time to have it (noselift) done? Let us state the facts: new sets of friends, new environment, entering coed schools and of course the POWER OF YOUTH.
As the saying goes, its better to see a young woman coming out of an old car than an old woman coming out of a new car. How about make it YOUNG AND BEAUTIFUL GIRL….
PRESERVATION OF THE ASIAN FEATURES WITH ELEVATION OF THE NASAL BRIDGE USING GORE-TEX NASAL IMPLANT AND NASAL TIP DEFINITION USING SEPTAL AND CONCHAL CARTILAGE
Patient already have beautiful eyes and strong facial pillars even before the surgery. It is best not to alter this facial innocence – so to speak by making a very subtle augmentation and nasal tip defatting
The strokes of my surgery is not to make a pointed tip but rather make a very natural nose in harmony with the rest of the facial features. Attention to detail with symmetry even on the basal view is a gauge of a good rhinoplasty.
April 07, 2011 (THE STARS ARE SHINING BRIGHTER)
Previous nasal accidents causes crooked nose and when not corrected this will create an illusion of a wide midface area. The full beauty of the individual will not be well appreciated even if she has the other features of a moviestar such as well defined deep set eyes, almond shaped lateral canthal fold, high cheek bones, cherubic forehead and a sincere smile. Luckily she went to me before the last growth spurt of her nasal bone and we were able to correct her nasal asymmetry. Now, she is a very successful singer – actress and allowed her pictures to be posted in our website
(THE NEW FACE OF SHIMMIAN —— Ms. Bernie Ann Estiandan)
April 01, 2011 (RHINOPLASTY AS YOUR BEST VISIBLE ASSET)
Some patients have been asking me on the benefits of rhinoplasty. I should be the last person to be asked when it comes to such coz I might be biased – being rhinoplasty as my profession. Beauty is very relative, some have small flat noses and yet looks cute on them. The best thing which I have observed thru the years of my practice is the creation of a “noble look” after rhinoplasty. It leaves an impression that the person belongs in the higher circles of our society. It makes them more confident in their work and daily activities . Moreover people around them feel that they are more approachable and comfortable to talk to.
A lot of persons are dreaming of luxury cars, bags or jewelries and are totally consumed in having them. In fact in this lifetime you just need a couple of good suits, a dependable car and the BEST CRAFTED NOSE.
March 27, 2011 (BOUNDLESS BENEFITS AFTER RHINOPLASTY)
“IT HAS ALREADY BEEN EMPHASIZED BEFORE THE BENEFITS BROUGHT ABOUT BY RHINOPLASTY. IT ELEVATES ONCE SELF ESTEEM WHICH IN TURN BRINGS BETTER OPPURTUNITIES IN LIFE . IT’S THE ONLY SINGLE SURGERY THAT CAN CHANGE ONCE OUTLOOK IN LIFE”
PROFILE VIEW
March 23, 2011 (NOSE IS 80% OF THE FACIAL BEAUTY)
Surgical enhancement of the nose has the most impact on overall facial beauty. It is the only anteriorly projecting part of the face that acts as a driver carrying all of the components of the face. It dictates the direction, projection and orientation of other facial features such as the cheek and chin alignment and the philtral advance which is a key feature if you have a happy or sad smile.
PROFILE VIEW
March 20, 2011 (LONG TERM RESULTS OF GORE-TEX NOSELIFT)
Gore-tex implant has been proved in several short and long term studies to be safe and provides a more natural looking noselift. Here is one of my early cases of rhinoplasty performed 7 years ago with impressive results. There is linear delineation of the nasal bone which has incoporated thru the implant and definition of the nasal tip.
PROFILE VIEW
March 17, 2011 (CORRECTION OF THE BULBOURS TIP WITH LATERAL NASAL EXCISION)
Most Filipinos have mestiza features that are are overshadowed by the amorphous shape of the nose. Just to state further on the importance of nasal beauty. It is the only anteriorly projecting part of the face and a small reorientation contributes to accentuation of other components of the face.
The bulbous nose is the 2nd most common type of case I have encountered in my years of Rhinoplasty. It is one of the most challenging and yet is the one I enjoy most. The results are really life changing and could change your perspective of how beautiful life is.
March 13, 2011 (CORRECTION OF THE BULBOUS TIP WITH LATERAL NASAL EXCISION)
The profile view is as important as the front view. It provides the noble look that all of us so desires. When people talk to each other they look directly into the eyes. They obseve the sincerity in your eyes and then observe the beauty of the nose. As the conversation goes on, you can feel that sense of comfort and confidence if you have the “noble look”. The height of the nose as viewed on the profile view gives us that sense of nobolity for more confidence in all of our daily undertakings in talking your way with your superiors to have that much needed promotion or simply charming a long cherished somebody
March 10, 2011 (CORRECTION OF THE WIDE BRIDGE AND FLARING ALAE)
Another patient with wide bridge and flaring alae that has been corrected with medial and lateral osteotomy in addition with alar base surgery.
March 07, 2011 (CORRECTION OF THE WIDE BRIDGE AND FLARING ALAE)
Osteotomy (or narrowing of the nasal bones) and alar base surgery are the two main surgical techniques employed when correcting this nasal condition. The change in the effective width of the nose will give more eye depthness and provide more emphasis on the chin and cheek angle.
March 04, 2011 ( CORRECTION OF THE INJECTED NOSE)
Silicone oil should never be injected into the nose. It is an industrial material that causes pressure necrosis and dermal thickening making it almost impossible to remove. Some entreprenuing individuals even pass this as collagen material and sell them on a per ml basis. For patients please examine the material to be injected to you, THE BEST MATERIAL RIGHT NOW ARE THE ONES MADE OF HYALURONIC ACID (Restylane, Juviderm etc.)
AFter 3 hours of careful dissection we were able to remove the silicone oil en bloc. It is like a yellowish jelly material admixed with soft tissues that has been incorporated with the foreign body. WE augmented the bridge using gore-tex implant and projected the tip using septal cartilage.
FEBRUARY 28, 2011 (CORRECTION OF THE SHORT NOSE)
Only the use of septal cartilage is strong enough in order the elongate the nose and correct the upturned deformity. This case is a classic example of showing the beauty of the eyes by rhinoplasty.
FEBRUARY 27, 2011 (ORIENTAL RHINOPLASTY)
The nose is 80% of the facial beauty. It is the only anteriorly projecting part of the face that acts as a driver to complement other facial features. In this case, the increase in the nasal height also improves the depthness of the eyes and angulation of the mouth in relation with the cheeks and chin.
FEBRUARY 24, 2011 (CORRECTION OF A CROOKED NOSE)
Patients with this kind of nose suffers from nasal obstruction on the deviated side. The deviation could be pure cartilage or a combined bony/cartilage malformation. A structural rhinoplasty using strong spreader grafts could improve the condition which is combined aesthetic and functional in nature.
FEBRUARY 20, 2011 (IDEAL NASAL PROFILE)
For Asians, the height of the nose should begin just on the fold of the eye. Nowadays the standards of beauty have become so high that people dont just look on the front view but on profile view as well. With the right height there is the benefit of Westernization of the Oriental face coupled with a preservation of ethnic beauty
FEBRUARY 17, 2011 (RHINOPLASTY IN A YOUNG PATIENT)
For females the last growth spurt of the nasal bone occurs on or before the 14th year of age (males last growth spurt is 16 y.o.) hence it is already safe to undergo rhinoplasty as early as 16 y.o. for females and 18 y.o. for males
FEBRUARY 13, 2011 (CORRECTION OF THE CAUCASIAN NOSE)
Characteristics of a caucasian nose are stong upper and lower cartilages, medium to thin skin and high nasal dorsum. I performed hump removal in this patient with septorhinoplasty to correct a deviated septum. This was followed by transdomal suturing and a small cap graft on the nasal tip to make it more refined looking. Observe the nasal tip derotation on the profile view to project a ” noble look”
FEBRUARY 10, 2011 (CORRECTION OF THE BULBOUS TIP AND SHORT NOSE)
Only the septal cartilage is durable enough to increase nasal tip projection and decrease tip rotation. In this case, I have used bilateral extended spreader grafts to make the nose as long and as high as possible.
Gore-tex is an implant material used only for the nasal bridge and should not be used to enhance the nasal tip. Only autologous grafts such as the ear, septum and costal cartilage can be used for this part because of infection risk . The two joints of the nose are located here which are very prone to entry of contaminants during dissection. Some surgeons use the gore-tex for the nasal tip with disastrous results.
FEBRUARY 07, 2011 (CORRECTION OF THE BULBOUS TIP AND FLARING ALAE)
The key to correction of the bulbous tip is to adequately redistribute the amorphous skin after defatting on the supratip area. After accomplishing this vital step, strong septal cartilages will be used in order to increase nasal tip definition.
Alar base surgery on the other hand depends on the surgeons skill – to gauge on how to make the nostrils smaller and yet maintaining the vestibular sleeve that makes the nostrils natural looking
FEBRUARY 04, 2011 (CORRECTION OF THE “ANDY GUMP” DEFORMITY AND ARROW NOSE)
Gore-tex can also be used for augmenting other facial parts. In this case we corrected a congenital shortness of the chin with the use of 2 layers 5 mm gore-tex. Furthermore the nasal tip was derotated to correct nasal droopiness.
JANUARY 30, 2011 (CORRECTION OF THE DIVERGENT ALAE)
As had been stated in my previous lectures, beauty is about harmony and symmetry. Reduction of the nostrils in this case does not correct the problem but in fact makes it worse, hence I have to perform combined alar base with osteotomy and defating of the supratip area.
JANUARY 24, 2011 (THE MALE RHINOPLASTY)
Characteristics of the male rhinoplasty
1. it should be more wide in the nasal bridge,
2. it should show some strength in nasal tip
3. more straight contour by profile view
The nasofrontal angle is more obtuse and the angle of divergence is around 60 degrees. Proper identification of facial landmarks is crucial to avoid “feminization of the face”
JANUARY 20, 2011 (SUBNASALE FLAP) – “published in the Plastic and Reconstructive Journal of March 2007 with yours truly as correspondent “
I made this paper some 8 years ago and was given approval for publication last March 2007. Most doctors will attest to the degree of difficulty in having a paper published in an international journal. Nowadays it has been in use not only for tip reconstruction but also for correcting congenital nasal tip malformation.
JANUARY 17, 2011 (CORRECTION OF THE BULBOUS TIP)
In frontal view, the ideal nose should be a gentle gull wing in flight (left photo), however nasal adaptation to humid climates has the genetic evolution among Asian nose to have more subcutaneous fats in the nasal tip area. This creates a very amorphous shape with weakness in the cartilages around the nostrils. With structural rhinoplasty we can contour in precision the needed tip of the nose and defat surrounding soft tissues, however patients should have realistic expectations that even after this procedure the nose skin has its own memory and takes time before it redrapes to its present structure.
( IDEAL NOSE) (BULBOUS NOSE)
The skin is like a leather that in some cases it takes years before it finally redrapes. I advise my patients for monthly triamcinolone injection in the nasal tip to help resolve the swelling.
(BULBOUS NOSE) (MEDIUM TO THIN SKIN)
JANUARY 10, 2011 (NASAL TIP SURGERY)
Nasal tip surgery is one of the most challenging aspect of rhinoplasty. It will differentiate a novice surgeon from a surgeon who has vast experience in cartilage grafting and tip – supratip remodelling. I always ask my patients to grade themselves from 0-10 before the surgery. Those whose grade are from 0-6 benefit most from cosmetic surgery. However grades bordering from perfection like 7-8.5 have to carefully choose their surgeons to achieve their aesthetic desires.
In this case, I removed a very small hump, refined further the nasal tip and augmented a small chin. Too small as it seems to be but this it took me full 3 hours to achieve the final look.
JANUARY 03, 2011 (FACIAL REJUVENATION CASE)
The nose is 80% of the facial beauty however because of aging other facial features have to be enhanced as well as one reaches the age of 45. At this time deep furrows on the glabellar area and the cheeks begins to show as well as large jowls on the side of the cheeks . She underwent full face stem cell fat transfer, augmentation rhinoplasty, facial liposuction, buccal fat removal and MOSAIC fractional laser treatment of the skin.
DECEMBER 25, 2010 (CHRISTMAS DAY CASE)
The gore-tex implant takes a longer time to heal , the patient should be aware with this so as not to have unrealistic expectation. The golden period is around 3 weeks before you could truly appreciate the new look that you have. In this case, as mentioned before , nasal physiognamy has great influence on patients before undergoing surgery. WE extended the nose as long as possible with the use of bilateral grafts harvested from the nasal septum.
DECEMBER 22, 2010
A lot of Filipinas have mestiza features (clear white skin, deep set eyes with high double folds, cherubic forehead and heart tapering jaw bone). All these features will blend well with augmentation of the nasal bridge and nasal tip definition. Patients who have their surgery at a younger age will have more oppurtunities in life (like better job offerings, better partners, etc…). Its importance has long been documented in several psychology and aesthetic surgery journals.
DECEMBER 20, 2010
During my lectures I always emphasize that beauty is all about harmony and symmetry. People nowadays look at you not only in front view but on profile view as well, hence the term “crafting the ideal nasal profile.” The side appearance of the person higlights the nobolity in each of us. Here is a case wherein we augmented the midnose and extended the nasal tip bringing a more symmetrical and harmonius look in both frontal and profile view
3/4 Profile view
DECEMBER 18, 2010
In Chinese physiognamy an upturned nose correlates to being unsuccessfull or unfortunate in life. Aside from this belief, persons who have this corrected will appreciate a more “comfortable look” in day to day activities. In here we used bilateral extended spreader grafts with composite grafts on both ears.
DECEMBER 16, 2010
Some patients may request for a creation of a ”pseudohump” or the look of an overgrowth in the middle portion of the nasal bridge during a surgery of the short nose with nasal tip definition. This will create an illusion of a narrower nose and a “sophisticated or noble look” that will fit well with strong features of the chin and cheeks
DECEMBER 11, 2010
This is a case of a 32 year old female who had infection and residual tip deformation from a silicone implant. The implant was replaced with gore-tex and nasal tip surgery using strong strut graft was performed. SUBNASALE FLAP which is a skin flap from the inside of the nose was used to correct the defect. (This kind of flap was an innovation of yours truly during my fellowship training in Seoul, Korea)
DECEMBER 04, 2010
Some patients who works for modelling or advertising agency wants a prominent nasal bridge. This is another option that you can discuss with your surgeon prior to the procedure. The lighting effect of the TV cameras gives emphasis on the angulations of the nasal bridge.
NOVEMBER 27, 2010
The basal view (worm’s eye view by layman’s term) is as important as the frontal and profile view. After the surgery with the nasal cast on, it is one of the first views observed by the patient as they try to familiarize themselves with their new look . It is also a gauge on the surgeons familiarity with the nasal anatomy and how he handles the skin-soft tissue during dissection.
Correction of the bulbous tip is one of the most challenging aspects of rhinoplasty. The thick skin acts like a leather that refuses to redrape into the new nasal stuctures. Aside from the proven use of strong support grafts, the surgeons artisty if of utmost importance as one tries to manuever the skin with the new structure without making the nose look bigger.
PROFILE VIEW
A nose injected with silicone oil develops some form of siliconomma that is very difficult to remove. Only thru an open approach and sharp dissection of the injected material can this condition be properly addressed. DMPS (silicone oil) has already been banned because of its detrimental effects unfortunately its use is still prevalent in our country.
NOVEMBER 20, 2010
23 year old with previous cleft repair (2x). He underwent RECONSTRUCTIVE RHINOPLASTY with subnasale transposition flap in this clinic. Bilateral extended spreader grafts were used for the nasal tip.
22 year old female with previous augmentation rhinoplasty (3x) complaining of loss of tip support with irregular nasal dorsum. REVISION RHINOPLASTY was performed in this clinic using strong strut graft from the septal cartilage and replacement of the silicone implant with ePTFE (gore-tex)
22 year old male who came into the clinic for PRIMARY AUGMENTATION RHINOPLASTY. Increase in nasal tip definition was achieved with the use of septal cartilage and ear cartilage harvested from a small cavum incision. For the nasal bridge 6 mm ePTFE (gore-tex) was used to have a natural look.
