The Seattle

Plastic Surgery Center

William A. Portuese, M.D.

Facial Plastic Surgery Questions and Answers: Part 01

Question:  Doing lower eyelid surgery to get rid of wrinkles. Will the old scar stay or should it be removed?
Answer: Much more information is needed, such as a full set of facial photographs of the eyelids. The primary goal for lower eyelid surgery is to remove the fat creating the puffy look. If there is excess skin in the lower lids, a pinch technique can remove it. It’s difficult to remove wrinkles in the lower lids since only conservative amount of skin can be removed in that area.

Question: SMAS and pixie ears. How do I address my concern with my doctor?
Answer: It’s best to study your prospective surgeon’s before and after facelift photo gallery to make sure there are no pixie ears in the after photos. Also discuss it with them ahead of time.

Question: Are cheek implants a good solution for adding volume?
Answer: Yes, cheek implants offer permanent volume to the mid-face and cheek area. The implants themselves are manufactured in a large array of thicknesses, sizes, and shapes which is best determined at the time of the consultation and examination. They are placed through an intra oral incision under a brief general anesthesia as an outpatient procedure.

Question:  Is it possible to reduce the size of my nose, lower my bridge, and reduce my bulbous tip?
Answer: A revision rhinoplasty procedure can accomplish shaving down the dorsal hump which is composed of both bone and cartilage, refinement of the nasal tip, and narrowing the bridge line. A closed rhinoplasty approach can accomplish this with all the incisions placed on the inside of the nose. No external incisions are required, and no people packing is required. Digital computer imaging would be helpful to understand what can be accomplished with the procedure. Revision rhinoplasty is one of the more difficult procedures to perform correctly in the entire field of cosmetic surgery, so it’s important to choose your surgeon based on extensive experience.

Question: Brow lift versus upper lid excess skin removal, any suggestions?
Answer: The height of your eyebrows from this one limited photograph are adequate, therefore brow lift is unnecessary. An upper blepharoplasty procedure can accomplish removal of excess skin on the upper lids and making them look more symmetrical. A lower blepharoplasty procedure can accomplish removal of the fat that is creating the puffy look on the lower lids.

Question:  What can be done to fix my boxy nose and make my nose slightly shorter?
Answer: A closed rhinoplasty approach can accomplish narrowing the bulbous nasal tip with conservative cartilage removal and suture techniques. The projection of the nose can only be decreased approximately 3 or 4 mm at most. Thick skin in the tip of the nose is going to prevent refinement in that area, so is very important have realistic expectations.

Question: What should I do to improve the balance and aesthetics of my face?
Answer: From the photographs presented, your nose looks pretty good and only a very minimal amount of change would be required. Always best assess the risk versus reward ratio when such a minimal amount of improvement is needed You do not need a chin implant since you have adequate projection of the chin itself. A very conservative skin only upper blepharoplasty can accomplish getting rid of the hooded look if that really bothers you.

Question:  I’m having a facelift and a blepharoplasty done by two different surgeons (it’s my preference). Which one should I do first?
Answer: It does not matter which procedure is performed first, but if you are undergoing general anesthesia for both procedures you should probably separate. Them out in time by at least 1 month. It is important understand the urine had 2 weeks of visible bruising and swelling after each procedure. Most patients undergo both procedures simultaneously under one anesthesia which allows one recovery period.

Question:  Inverted V after rhino. What option should I choose?
Answer: Much more information is needed, such as a copy of your operative report to find out how much cartilage you have leftover on the inside of your nose for grafting purposes. The inverted V deformity is treated with osteotomies placed in the wide nasal bones to narrow them, and spreader graft placement in the upper lateral cartilages to widen them and give more support.. Your nostrils are asymmetrical now and will still be asymmetrical after the surgery, but they could probably be improved only slightly.

Question:  Would I be a good candidate for buccal fat removal combined with a revisions facelift?
Answer: In our practice we do not perform buccal fat pad removal since you’re going to lose fat deposits in the face anyway with the aging process. Choose your facelift surgeon very wise a based upon extensive experience producing natural results. Study your prospective surgeon’s before and after facelift photo Gallery make sure you like the results.

The Seattle

Plastic Surgery Center


Award Winning Highly Rated & Reviewed plastic surgeon Dr & medical clinic serving Seattle Wa 98104, King County, Bellevue, Kirkland, and Surrounding Areas. We offer a variety of surgical procedures and non surgical treatments for enhancement and rejuvenation.

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