The Seattle

Plastic Surgery Center

William A. Portuese, M.D.

Facial Plastic Surgery Questions and Answers: Part 03

Question: Callous 1 year post rasping revision rhinoplasty. Is another rasping needed? Should I go with a different doctor?
Answer: Revision rhinoplasty is more difficult than a primary rhinoplasty due to the fact there has been previous alterations to the normal anatomy and scar tissue present. Much more information is needed, such as a full set of facial photographs from all angles, and copies of the operative reports. It is important to know if there is any cartilage left over on the inside of the nose for grafting purposes since the midportion of your nose appears collapsed inward creating a relative bump. That are may need spreader grafts in addition to shaving down the dorsal hump.

Question: Rhinoplasty for ~ $8,000 in US? Plastic surgery recommendations?
Answer: A closed rhinoplasty approach can accomplish shaving down the dorsal hump, narrowing the bridge line and refining the nasal tip cartilages with all the incisions placed on the inside of the nose. No external incisions are required, and no painful packing is required. Also important to know that there will be several follow-up appointments required with your surgeon after the plastic surgery to monitor the healing of the nasal tip which may include steroid shots for the first few months after the procedure.

Question: Which procedures can give me a slimmer neck/jawline profile?
Answer: From the limited photograph, it appears that there is a recessive chin profile present, so a chin implant can augment the chin forward which will give better structural foundation for the soft tissues in the neck. A surgical neck lift procedure accomplishes removal of fat deposits above the muscle with liposuction and surgical extraction of the fat deposits below the muscle which also includes a platysma-plasty. All this can be performed through a 1 inch incision underneath the chin.

Question:  I have been on and off considering a nose job for several years because I hate how it looks when I smile ?
Answer: A full set of facial photographs from all angles in repose, not while animated are required to make a determination about how best to proceed. Digital computer imaging also be helpful to understand what can and cannot be accomplished with a rhinoplasty procedure.

Question:  What kind of nose treatment would you recommend for the bridge of my nose?
Answer: A closed rhinoplasty approach can accomplish shaving down the dorsal hump, narrowing the bridge line, refining the nasal tip with all the incisions placed on the inside of the nose. No external incisions are required. To prevent the tip of the nose from drooping when smiling requires releasing of the depressor septi ligament.

Question:  What are the pros and cons of glabella removal?
Answer: The corrugator muscle can be reduced, partially removed and softened during a brow lift procedure.

Question:  Is a nose tip reduction possible without traditional rhinoplasty?
Answer: Much more information is needed, such as a full set of facial photographs from all angles to make a determination about how best to proceed, since the nose is a 3-dimensional structure, and rhinoplasty is performed in all 3 dimensions. Most patients must undergo a full rhinoplasty to ensure all the components of the nose are balanced with themselves, and the entire new nose is balanced with the patient’s facial features. The digitally altered photographs require a cartilage graft harvested from inside the nose in order to build up the area in the supratip depression that is shown in the digital altered photograph. Best to make an appointment with 3 busy rhinoplasty surgeons to discuss your options

Question:  Should I get upper or lower bleph? Would insurance cover it? It is affecting my peripheral vision.
Answer: The primary goal for upper blepharoplasty is to remove hooded and excess skin on the upper lids for functional purposes to improve vision, or for cosmetic purposes. For insurance billing, you must meet strict criteria by your medical insurance and has been documented with photographs, chart notes, and visual field

Question:  10 months after my rhinoplasty my tip has drooped and I have a hump again – will I need a revision?
Answer: A closed revision rhinoplasty can accomplish shaving down the residual dorsal bony hump, lifting the tip slightly and straightening your nose. Also important to release the depressor septi ligament which dynamically pulls your tip down when smiling. It’s important to know how much cartilage is left over on the inside of the nose for grafting purposes, since you’ll probably need a spreader graft on the concave (your left) side of the nose. Revision rhinoplasty is more difficult than the primary rhinoplasty, so choose your surgeon very wisely based on extensive experience.

Question: Crease across my forehead droops downward – would a temporal brow lift help?
Answer: A full set of photographs of your eyes and forehead are required make make a determination about how best to proceed. The primary goal for upper blepharoplasty is to remove the excess skin resting on your eyelashes creating the tired look. A brow lift procedure can accomplish softening the vertical and horizontal lines of the forehead in addition to lifting low set eyebrows. You can also try Botox in your forehead first to see if that relieves both the vertical and horizontal lines before a surgical brow lift.

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Plastic Surgery Center

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