The Seattle

Plastic Surgery Center

William A. Portuese, M.D.

Facial Plastic Surgery Questions and Answers: Part 08

Question: Rhinoplasty with rib cartilage – does cartilage wrap over time and can volume be increased to minimize graft size?
Answer: In our practice, we do not recommend rib graft rhinoplasty for a variety of reasons which you have mentioned in your question. 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 with your nose.

Question: Am I a good candidate for Chin Liposuction with Renuvion? Seeking a second opinion
Answer: From this photograph, you have significant fat deposits located above and below the platysma muscle in your neck. The majority of your fat deposits are located below the muscle. Liposuction can only remove the fat deposits above the muscle which will be minimally effective. You going to need a surgical neck lift with a platysma plasty to remove the fat deposits above and below the muscle to significantly improve your jawline.

Question: Can rhinoplasty cause a lower smile line/change in lip position?
Answer: No, a rhinoplasty procedure involves altering the cartilage and bone in your nose. Releasing the depressor septi ligament simply prevents the tip of the nose from drooping down dynamically when you smile. It has no bearing on your lip and how much of your teeth.

Question:  Should I expect faint scarring after a facelift and will this be noticeable to others?
Answer: It’s very important to look at your prospective surgeon’s after results in their facelift photo Gallery, and make sure the hair is pulled up above the ears so that you can see what the incisions look like. Choose your surgeon very wisely based on producing natural results.

Question: Revision Rhinoplasty or Columelloplasty? Which procedure would help correct hanging and asymmettrical columella?
Answer: Revision rhinoplasty is the most difficult operation to perform correctly in the entire field of cosmetic surgery, therefore a full set of facial photographs from all angles are required to make a determination about which procedure is going to be the best for you. A revision rhinoplasty with or without columella- plasty can be performed by a closed rhinoplasty approach with all incisions placed on the inside of the nose. No external insertions are required, and no painful packing is required either.

Question: 32 year old male – what are my options to reduce the appearance of puffy eyes? 
Answer: First of all you could try a low salt diet to see if that helps with the puffiness in your lower lids. The photographs demonstrate herniated fat pads in the lower lids which usually requires a lower blepharoplasty procedure to improve. A trans conjunctival approach lower eyelid surgery can accomplish removal of those bags with two small incisions on the inside of each eyelid. No external incisions are required. The Procedure is performed under a brief general anesthesia as an outpatient procedure.

Question: Which procedure option is best to help minimize the appearance of a double chin / weak jaw line?
Answer: The Side profile photographs demonstrate a recessive mandible and weak chin profile. Consider placement of a chin implant to augment the chin forward for better facial balance and proportions. The procedure can be performed under local anesthesia as an outpatient procedure which takes approximately 30 minutes.

Question:  Are there alternatives to a columella strut that can support a thick skinned nose tip? 
Answer: In our practice, we do not use a columella strut due to the issues you mentioned. A closed rhinoplasty approach can accomplish shaving down the slight dorsal hump, lifting the nasal tip, reducing hanging columella, and narrowing the bridge line with all incisions placed on the inside of the nose. Also important to release the depressor septi ligament which dynamically pulls the tip downwards when smiling. Choose your surgeon wisely based on extensive experience producing natural results.

Question:  What would you advise for my sagging jawline and double chin?
Answer: At age 44, you do not need a facelift. The photographs demonstrate a recessive chin profile and significant fat deposits in the neck above AND below the platysma muscle. A neck lift procedure can accomplish removal of fat deposits below the platysma muscle which also includes a platysma plasty to significantly improve the jawline. Consider placement of a chin implant augment the recessive chin forward for better facial balance and proportions. Both procedures can be performed through A 1 inch incision underneath the chin. No skin removal is required. Liposuction alone will only accomplish removal of fatty deposits above the platysma muscle which will be only minimally effective.

Question:  Not a fan of my profile. Would you suggest a lift or a chin implant?
Answer: A chin implant procedure can accomplish augmenting the recessive chin forward for better facial balance. Once you are at your ideal body weight, then consider a neck lift procedure to remove fat deposits in the neck which also includes the platysma-plasty.

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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