The Seattle

Plastic Surgery Center

William A. Portuese, M.D.

Facial Plastic Surgery Questions and Answers: Part 05

Question: How can I improve my nose and what kind of nose job would you suggest?
Answer: A closed rhinoplasty approach can accomplish straightening the nose, refining the nasal tip, and narrowing the bridge line with all incisions placed on the inside of the nose. No external incisions are required and no painful packing is required. Also important to release the depressor septi ligament which pulls the tip down dynamically when you smile. It appears that you have thick skin in the tip of the nose which will require steroid shots for the first few months after the procedure in order for the tip swelling to heal properly.

Question: Is my already thin nose a candidate for rhinoplasty?
Answer: A closed rhinoplasty approach can accomplish shaving down the dorsal hump, decreasing the projection of the nose and widening the mid-portion of the bridge line with spreader graft placements. This may also help with dynamic collapse on inspiration. It is important to release the depressor septi ligament which pulls the nasal tip down dynamically when smiling.

Question: Which procedures will give me the best aesthetic/rejuvenation improvement?
Answer: From the photographs presented, you’re an excellent candidate for a facelift and upper blepharoplasty procedure. In our practice, we do not recommend fat transfers, lip lifts, and phenol peels due to complications we have seen from those procedures.

Question: Is there such a thing as a comprehensive deep plane facelift vs a less comprehensive deep plane facelifts?
Answer: In our practice, we do not perform a deep plane facelift because there’s a higher risk of facial nerve paralysis. We perform a high-SMAS comprehensive lower face and neck lift. This procedure accomplishes tightening loose facial and neck skin, tightening loose facial and neck muscles, lifting the jowls, and removing fat deposits above and below the platysma muscle in the neck in addition to a platysma plasty. This procedure takes approximately three hours. The mid- face is treated differently with cheek implants to restore lost volume.

Question: Is this sagging or fat under my chin? 25f, 145lbs.
Answer: The limited photographs demonstrate that deposits in the neck. At age 25, your skin tone is excellent. Consider liposuction to remove the fat deposits which can be performed under local anesthesia as an outpatient procedure.

Question:  What is the best solution for my profile and jawline?
Answer: From the one brother limited photo, it appears that there are fat deposits in the neck which are going to be located above and below the platysma muscle in the neck itself. Liposuction can only accomplish Removal of fat deposits above the muscle, while a surgical neck lift is required to removed the fat deposits below the platysma muscle which also includes a platysma-plasty to significantly improve the jawline.

Question: Is the profile view shown in the example “after photo” possible, based on my current profile?
Answer: The photographs demonstrate an overly projecting nose and an under projecting chin. Consider a closed rhinoplasty procedure to accomplish shaving down the dorsal hump, decreasing the overall projection of the nose and refining the nasal tip and narrowing the Bridge line. All incisions are placed on the inside of the nose. Consider augmenting the chin forward with a chin implant procedure for better facial balance and proportions. In our practice for over 25 years, we have used Implantech brand of solid silicone chin implants that are placed through a small incision underneath the chin.

Question: Had my rhino/septoplasty in 2015. Unhappy with my nose, not as feminine as I hoped it would be.
Answer: Revision rhinoplasty is more difficult than a primary rhinoplasty, so it is important to have realistic expectations, since there is never a perfect nose. A closed rhinoplasty approach can accomplish shaving down the residual dorsal hump, and straightening the nose. You may require a composite skin graft from the ear to repair the left-sided nasal/alar retraction. Thick skin in the tip of the nose prevents refinement in that area, so that area will be changed all that much. It is also important to know how much cartilage is left over on the inside of the nose for potential grafting purposes.

Question: What can I do to minimize the appearance of drooping eyes caused by aging?
Answer: An upper blepharoplasty procedure can accomplish removal of the extra hooded skin and a small amount of fat from the upper eyelids to rejuvenate them. This procedure can be performed under local anesthesia as an outpatient procedure.

Question:  Which procedure would help minimize the appearance of small double chin and lines?
Answer: Much more information as needed, such as a full set of facial, Chin and neck photographs to make a determination about how best to proceed. A mini facelift would be required for extra skin removal, a neck lift would be performed for fat removal in that area, and a chin implant is used for the recessive chin profile.

The Seattle

Plastic Surgery Center

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