David W. Kim, MD

Rhinoplasty should create a result in which the nose looks good, functions well, and fits the patient’s features. These pictures show the immediate result from a rhinoplasty I performed a few days ago in a very bright and precocious teenager. As a tall young man, he needed a strong nose which fit his stature and facial features. Although the hump is often the treatment target for rhinoplasty, in his case, adding projection to the tip of the nose was also critical. With th...ese changes he now has an attractive, functional, symmetrical, and masculine nose which suits him. Most importantly, he saw these pics right after surgery and was thrilled with the results! #rhinoplasty #rhinoplastyspecialist #rhinoplastybeforeandafter #beforeandafter #facialplasticsurgery #aafprs #sanfrancisco #davidwkimmd #cosmeticsurgery #transformation #nosejob #nose #cosmeticrhinoplasty #functionalrhinoplasty #naturalisbeautiful #humpreduction #nasaltip #crookednosesurgery

Botox is famous for their wrinkle-erasing capabilities. A lesser-known, but increasingly popular use of Botox is to reduce the size and strength of the masseter muscles located at the back of the jawline. This simple, yet effective treatment can have both health and beauty benefits oftentimes quite dramatic! #jawlinegoals #jawlineslimming #jawlinefiller #jawlinecontouring #dermalfillers #fillers #jawlinefillers #juvederm #cheekbones #filler #jawlineonfleek #lips #botox #jawlineme #antiwrinkle #lipfillers

The combination of hump reduction and tip elevation can create a stunning but natural transformation for the right patient. The 2 month post-op photos of my beautiful patient picture shows what this combination of techniques can achieve. She feels her nose looks prettier, more feminine, and better defined already, only 2 months since surgery! #rhinoplasty #rhinoplastyspecialist #rhinoplastybeforeandafter #beforeandafter #facialplasticsurgery #aafprs #sanfrancisco #davidwkimmd #cosmeticsurgery #transformation #nosejob #nose #cosmeticrhinoplasty #functionalrhinoplasty #naturalisbeautiful

A botched rhinoplasty can be a traumatic experience for a person. One goes from having hopes of a more attractive nose to living with a deformity. Goals for revision rhinoplasty are therefore a little different than in first time surgery. Revision is about restoring the nose to health, function, and normalcytaking away problems which distract or inhibit someone from looking and feeling normal. These photos taken today show the one week results of a revision rhinoplasty I... performed on a wonderful woman who had been living with deformity and obstruction related to past rhinoplasty for over 20 years. She was afraid to undergo additional surgery based on her previous bad experience, but she took the leap of faith to entrust me to revise her nose. It was a difficult 6 hour procedure involving cartilage grafts from her septum and ear to restore structure and fascia and fat grafts to rejuvenate and thicken her damaged skin envelope. After the cast came off, I could see the relief and emotion come out as she shed happy tears. Now that the physical state of the nose is restored, it will take more time for the swelling to come down and the skin to recover, but she is well on her way toward moving on from having to spend energy and worry about her nose. #rhinoplasty #revisionrhinoplasty #rhinoplastyspecialist #rhinoplastybeforeandafter #beforeandafter #facialplasticsurgery #aafprs #sanfrancisco #davidwkimmd #cosmeticsurgery #transformation #nosejob #cosmeticrhinoplasty #functionalrhinoplasty #naturalisbeautiful #grateful

The post-traumatic crooked nose is one of the more challenging problems in rhinoplasty. Why? There are several several reasons. 1. The foundation of the nose (septum and bones) are usually distorted. 2. The potential causes of the crookedness can vary from person to person, so the surgery requires a different approach for every case. 3. There are usually simultaneous issues of cosmetic deformity and nasal obstruction. 4. With old injuries, the structures have settled i...nto their positions and don’t easily change. 5. Building material from the septum (cartilage grafts) may be in short supply because of distortion from injury. These issues make crooked noses challenging but also gratifying to fix. This morning I operated on a young man who had bent, obstructed nose caused by childhood trauma. He lived most of his life unable to breathe from his left side and with worsening asymmetry of his external nose. Surgery involved reconstruction of the bent septal foundation, repositioning of his bones, and finally reconnecting his bridge and tip cartilages on this foundation. During the procedure, an area of jutting bone from the septum was removed to open his nasa airflow (last pic). Looking forward to seeing him in follow up and tracking him progress for breathing and swelling reduction going forward. #rhinoplasty #crookednose #rhinoplastyspecialist #sanfrancisco #rhinoplastybeforeandafter #beforeandafter #davidwkimmd

The columella (bridge of skin between the nostrils) is often overlooked when considering nasal aesthetics. It can also be a problematic area in rhinoplasty if the nose is treated only by reduction and made to be unstable. This young woman presented to me, unhappy with the results from previous rhinoplasty. She felt the base of her nose looked heavy and asymmetrical. I performed revision rhinoplasty on her nose one week ago. The problem was a hanging, downward curving col...umella in combination with a retracted left nostril. When I opened her nose, I discovered damaged, reduced tip cartilages, missing septal foundation, and lots of dense thick scar tissue pulling the nostril margin up. Using structural cartilage grafts (septal extension graft and lateral crural grafts), I was able to create a better foundation to pull her columella back up, project her tip, and lower her right nostril. The photos show a one week result from today. Even with her swelling, she is already happy with the shape and felt that the improved balance between the columella and nostril position made her nose look much more natural and attractive. #rhinoplasty #revisionrhinoplasty #rhinoplastyspecialist #davidwkimmd #naturalisbeautiful #beforeandafter

Form is function. If a nasal tip has normal shape and contour, it will look good on the outside and function well on the inside. This young woman presented to me with airflow problems and a desire for a better defined and more projected tip. The solution was to create a stronger and more appropriately shaped tip foundation. The two tip cartilages (there’s one on each side) were anchored to a strong septal extension graft between her nostrils in order to project and lift h...er tip slightly so it could be better aligned with her bridge. The tip shape and nostril openings were then straightened and strengthened with lateral crural strut grafts in order to create better shape, symmetry, and airflow. Just 5 weeks post-op from surgery, she is happy with the shape of her nose and clear nasal airflow. #rhinoplasty #rhinoplastyspecialist #cosmeticrhinoplasty #functionalrhinoplasty #hybridrhinoplasty #davidwkimmd #naturalbeauty #breathe #normalisbeautiful #happypatienthappysurgeon

Nasal deformities originating from early childhood trauma can create major functional and cosmetic problems. Not only is there immediate damage from the injury, the subsequent growth of the nose can become distorted, setting up a process in which the nose become progressively misshapen over time. These before and after photos show the result of a reconstructive rhinoplasty I performed yesterday on a young man who sustained blunt trauma to the nose as a young child. I harve...sted rib cartilage to rebuild his collapsed septal foundation, reconnect his nasal anatomy onto that foundation, and smoothed and straightened his bones, bridge, and tip cartilages. Massive improvement in airflow and he now has a nose which looks much more normal and natural. As his swelling comes down in the next several month, he will gain back definition while maintaining this improved foundation and shape. #rhinoplastyspecialist #rhinoplasty #reconstructiverhinoplasty #davidwkimmd #naturalisbeautiful #functionalrhinoplasty #cosmeticrhinoplasty See more

Revision rhinoplasty often requires a duality of thinking, an engineering mindset, but also an artistic sensibility. Structures have previously been damaged so they need to be exposed and rebuilt and made to be strong. But in the end, the surface must be smooth and symmetrical and form the contours of an attractive and natural shape. Strength and beauty, foundation and surface. These are the yin and yang of rhinoplasty, especially with revision. The surgeon’s mindset go...es from engineer to artist, back and forth through these surgeries, frequently occupying both approaches simultaneously. It is truly an endeavor of the right brain and left brain working together! The photos that follow show a long term outcome from a revision rhinoplasty in which previous over-reduction made my patient’s nose weak. Through years of scar contracture, her surface become increasingly pinched and uneven. Through deconstruction-reconstruction revision, I was able to restore her nose to a stronger and more natural and attractive shape which also functioned more effectively. Not an easy one, but worth the effort in the benefit she was able to receive. #rhinoplasty #revisionrhinoplasty #rhinoplastyspecialist #davidwkimmd #naturalbeauty

When I met this patient, I was struck by her energy and positive outlook, despite the fact that she had significant problems with her nose caused by previous injuries and unsuccessful past rhinoplasty. During her revision, I discovered scar webs blocking her nasal passages internally and a structural framework which was weak and collapsed. Her septum had signs of severe past trauma and her nasal cartilages were overly reduced. Using grafts I created from her rib cartilage,... I was able to create a better proportioned and more symmetrical nasal framework. I was able to remove the scar webs causing the obstruction to open her nasal passages. These photos show her 2 week results. Even at this early stage with swelling on board, her nose is already more open functionally and looks attractive and natural. I’ve been amazed by her resilience through her hardships and am so pleased that she now feels good about the shape and function of her nose. #rhinoplasty #revisionrhinoplasty #rhinoplastyspecialist #davidwkimmd #positiveattitude #naturalbeauty

Life imitates art. First pic is a throwback to a visit to SF MOMA last year. The subsequent pics are one week post-op before and after photos of a lovely young woman for whom I performed rhinoplasty recently. I would never compare myself to the genius of Andy Warhol. But I would submit that changing a real nose is harder than painting one! There is artistry in rhinoplasty. But there is also science, medicine, engineering, mathematics, and psychology! #rhinoplasty #rhinoplastybeforeandafter #rhinoplastyspecialist #sfmoma #davidwkimmd #artandscience @ SFMOMA San Francisco Museum of Modern Art

Nasal aesthetics intrigue me because there is a wide range of what can be beautiful. This is critical to remember as a rhinoplasty surgeon. With such a diversity of backgrounds, different patients don’t always want the same outcome! In particular, with the nasal profile, there is room for a range of shapes. Ultimately, rhinoplasty should create a nose which fits the way each patient want to see themselvesinclusive of family or ethnic features. The before and afters her...e show a great example of an outcome which reflects my patient’s wish to improve her nose while retaining some of its original personality, befitting her Italian heritage. The result is a nose which is more refined and more feminine but still strong in character. She told me her new nose feels like the nose she was always meant to have. I’m grateful she allowed me to share her pics and experience and I’m so happy she is pleased with her outcome! #rhinoplasty #naturalnose #nasalbeauty #rhinoplastyspecialist #davidwkimmd #diversityisbeauty @ David W. Kim, MD - San Francisco

The vast complexity of rhinoplasty makes the surgeon’s learning curve a life-long process. Early in one’s career, surgeries are stressful as the surgeon navigates the steep part of the learning curve. Things become easier as one progresses to competency. But it’s after thousands of surgeries when one starts to approach mastery when it truly becomes gratifying. Of course it feels good to help patients by delivering outstanding results. But there is also a deep satisfaction in ...the processin which the actual surgery can become an exercise of FLOW, that state of mind when one is full of energy, happiness, and fully immersed in the activity. In order to reach this state, one must possess a high level of ability within a task that is highly challenging. As I enter the third decade of my career, I’m grateful to be in a profession in which I can frequently occupy this flow state. It’s these moments when I’m completely engrossed within the complexity and beauty of the nasal anatomy, I truly feel the joy of being a rhinoplasty surgeon. #rhinoplasty #flow #revisionrhinoplasty #rhinoplastyspecialist #davidwkimmd @ David W. Kim, MD - San Francisco

Because the nose projects from the face and is formed by delicate anatomy, it is one of the more vulnerable parts of the body. Nasal trauma can therefore result in significant functional and cosmetic problems. Today I had the privilege to treat a wonderful young woman with this exact problem, originating from a sports related injury in high school. Since that time she has lived with a crooked, obstructed, poorly aligned nose. Through structural rhinoplasty techniques, I was... able to remove her hump, straighten her bones and bridge, lift her tip, and straighten her septum. Already she is breathing better and was happy to see these immediate before/after pictures. #rhinoplasty #rhinoplastyspecialist #functionalrhinoplasty #cosmeticrhinoplasty #crookednoserhinoplasty #humpreduction #tiplift #septalreconstruction @ David W. Kim, MD - San Francisco

The difficult cases are sometimes the most gratifying. Feels good to be able to help this gentleman restore his nose to a more natural and masculine shape with better airflow. His first rhinoplasty created an unnatural shape which looked over-reduced and feminized (in addition to causing obstruction). The challenge of revision rhinoplasty in the over-reduced nose is creating a more appropriate larger framework which is also strong enough to push through the contracted scar t...issue. I used structural cartilage grafts taken from his rib to rebuild his nasal foundation, add height to the bridge, length and projection to the tip, and support and strength to his nasal valves (nostril openings). The result is a better proportioned, better functioning, more natural and masculine appearing nose. The after pics were taken right before the splint was placed on the nose. There is some swelling (mainly affecting the front view) which will resolve over the next several months, but the profile and base views show the immediate beneficial effects to proportion and function. #rhinoplasty #revisionrhinoplasty #rhinoplastyspecialist #ribgrafts #davidwkimmd @ David W. Kim, MD - San Francisco See more

Delighted to see this lovely young woman for her 1 month follow-up appointment today. She was almost completely obstructed in her left nasal passage and she always felt her nose looked crooked and uneven. It was a difficult surgery but went well and most importantly she is happy with her result. There’s still a bit more swelling which will resolve, but already she’s breathing normally and feels that her nose looks great! #rhinoplasty #rhinoplastysurgeon #crookednose #gratefulpatient #gratefulsurgeon

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