The Seattle

Plastic Surgery Center

William A. Portuese, M.D.

Facial Plastic Surgery Questions and Answers: Part 07

Question:  I need a revision rhinoplasty – please help me detail what my problems are, and what specifically can be done.
Answer: Revision rhinoplasty is the most difficult operation to perform correctly in the entire field of cosmetic surgery because there is extensive scar tissue present, and previous alterations to the normal anatomy. Usually an in-person examination is going to be required due to the complexity of this procedure. Its also important to know how much cartilage is left over on the inside of the nose for potential grafting purposes. It would also be helpful to have a copy of the operative report to find out what maneuvers were performed and your first rhinoplasty procedure. Osteotomies performed and the nasal bones will be certainly be required to narrow the bridge line. The previous spreader grafts may have to be removed/ shaved down to be able to narrow your nose. Trying to accomplish deprojection of the nose will only accomplish very small amount such as 2 mm.

Question: At 50, I’m looking to get neck skin tightened. It’s loose and I hate it! Trying to find out my options.
Answer: From the limited photographs, there appears to be fat deposits in the neck, jowls, and inelastic skin in the neck. A lower face and neck lift procedure can accomplish tightening loose facial and neck skin, lifting the jowls, liposuction to remove the fat deposits in the neck, tightening loose facial and neck muscles which also includes a platysma plasty to significantly improve the jawline.

Question:  I have olive tone skin. Will a facelift leave me visible scars?
Answer: A properly performed facelift should leave you with with minimally detectable incisions. It is important not to place any tension on the skin which can cause wide scars, and important to remove the sutures in a timely fashion to prevent railroad tracking scars. Study your prospective surgeon’s before and after face lift photo gallery and look for the incisions in the photographs.

Question: How Can I Fix the My Asymetrical Face?
Answer: Everyone has some degree of facial asymmetry, and the asymmetry in your eyebrows is normal. You can try Botox to help with some of the asymmetry on a temporary basis. A closed rhinoplasty procedure can accomplish straightening the nose, shaving down the dorsal hump, and refining the nasal tip with all of the incisions placed on the inside of it. No external incisions are required. Digital computer imaging to be helpful to understand what can be accomplished with your nose upon your facial features.

Question:  Can double chin lipo be used for fat grafting instead of body fat?
Answer: A full set of the facial photographs are going to be required to make a determination about how best to proceed with 2 surgical procedures. It is also important understand that there are 2 compartments of fat in the neck, and they are located above AND below the platysma muscle. Liposuction can only remove the fat deposits above the platysma muscle. A surgical neck lift is required to remove fat Deposits below the platysma muscle which also includes a platysma plasty to significantly improve the jawline. No skin removal is required in patient’s less than 50 years of age. When patients have a recessive chin, It is because there is a mandible bone deficiency. That must be augmented with hard chin implant which is a bony augmentation. Fat grafting is used for soft tissue augmentation. Fat grafting to the chin will not work very well.

Question:  Do I have a weak chin, overbite or what exactly is wrong with my face in your opinion? Is it the nose? Too protruding?
Answer: From the 1 side profile photograph, there appears to be a mild recessive chin profile present. Placement of a chin implant can augment the chin forward , but will have no bearing on how the teeth fit together. Chin implants are placed under local anesthesia as an outpatient procedure which takes approximately 30 minutes. If your teeth are significantly out alignment, then consider a sliding genioplasty performed by an oral surgeon. A sliding genioplasty is performed in a hospital setting under general anesthesia with an overnight stay at the hospital.

Question: If I deproject my nose, will I lose definition?
Answer: A full set of facial photographs from all angles are required to make a determination about how best to proceed, since the nose is a 3-dimensional structure and rhinoplasty performed in all 3 dimensions.

Question: Can a chin implant make a large forehead appear smaller?
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. Chin implants are only placed for patients who have a weak and recessive chin profile.

Question: Which procedure would best benefit my profile?
Answer: Much more information is needed, such as a full set of facial photograph from all angles, and your age. From the one limited photograph, it appears that you have a recessive chin, therefore consider placement a small chin implant to augment your chin forward for better facial balance and proportions. In our practice, this procedure can be performed under local anesthesia as an outpatient procedure which usually takes about 30 minutes.

Question: What is the difference between a surgical brow lift and a thread lift?
Answer: A surgical brow lift accomplishes either raising the hairline or lowering it depending upon placement of the incision, in addition to raising the eyebrows themselves for low set eyebrows. This corrugator muscles and frontalis muscles can also be softened to help with the wrinkles in the forehead. This is a permanent solution to both vertical And horizontal wrinkles in the forehead and is performed when patients have low set eyebrows. Threadlifts are only temporary since this it’s nonsurgical and the threads dissolve within a couple months.

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