The Seattle

Plastic Surgery Center

William A. Portuese, M.D.

Facial Plastic Surgery Questions and Answers: Part 09

Question: How can I improve the proportions in my face? Nose job and chin reduction? What procedures?
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. Digital computer imaging would also be helpful. The frontal profile photographs look great.

Question: Would I be a good candidate for a nose job? I’m scared that with my nose shape I might get botched
Answer: A closed rhinoplasty approach can accomplish narrowing the bridge line, nasal tip and nostrils with all incisions placed on the inside of the nose. No external incisions are required, no painful packing required either.

Question:  What can fix the bridge width and drooping tip of the nose?
Answer: A closed rhinoplasty approach can accomplish shaving down the dorsal hump, decreasing the overall projection of the nose, straightening the bridge line from the frontal view, and reducing the hanging columella. Also important to release the depressor septi ligament which pulls the nasal tip down dynamically when smiling.

Question: What kind of Facelift do I need?
Answer: The photographs demonstrate The normal facial changes of aging, especially jowls, and a prominent pre-jowl sulcus which is just in front of the jowl itself. Consider placement of a pre-jowl style chin implant to augment that area, since even a facelift will still leave you with a hollowness in that area. In our practice, we perform a high-SMAS lower face and neck lift which accomplishes tightening loose facial and neck skin, lifting the jowls, tightening loose facial and neck muscles, and removal of fat in the neck with liposuction in addition to a platysma-plasty.

Question:  What is the chance that a rhinoplasty using rib cartilage grafts will calcify long term?
Answer: Rib cartilage is only used as a last resort for grafting purposes. Always best to use nasal cartilage first, and if there is a cartilage depleted nose, then used ear cartilage. After rib has been placed in the nose, the nose will feel very hard and stiff.

Question: Will I be able to achieve something like this with rhinoplasty?
Answer: Yes, a closed rhinoplasty approach can accomplish shaving down the dorsal hump, refining the nasal tip, and narrowing the bridge line with all the incisions placed on the inside of the nose. Digital computer imaging of your nose upon your facial features would be helpful to understand what can be accomplished with the procedure. Rhinoplasty is a very difficult endeavor, so choose your surgeon wisely based on extensive experience.

Question: Would getting rhinoplasty done while being a bit overweight be a bad idea?
Answer: Much more information is required such as your height weight and body mass index before being able to answer your question. In addition, a full set of facial/nasal photographs from all angles are also required.

Question: Rhinoplasty on Thick Skin Nose?
Answer: It is certainly possible to undergo rhinoplasty with thick skin, but it is important have realistic expectations on what can and cannot be accomplished with the procedure. The thickness of the skin in the tip of the nose must be determined at the time of the In-person consultation. When patients have thick skin, they usually require multiple steroid shots placed in the tip of the nose to prevent excess swelling in that area over the first several months after the procedure. Digital computer imaging of your nose upon your facial features would be helpful to understand what can be accomplished with the procedure.

Question: Upper eye puffiness and asymmetry – am I candidate for a brow lift, blepharoplasty or something else?
Answer: There’s always a symmetry in the upper eyelids, both before and after the procedure. Your eyebrow position is normal, therefore a brow lift is not necessary. A conservative upper blepharoplasty procedure can accomplish removal of some of the excess fat creating the puffy look, and a conservative amount of extra skin. In upper blepharoplasty procedure can be performed under local anesthesia As an outpatient procedure.

Question: Have you heard of ‘mini’ rhinoplasty where the dorsal hump is shaved down?
Answer: There is no such thing as a mini rhinoplasty. You have a large dorsal hump and a droopy tip. The tip must be lifted upwards, and once the dorsal hump has been shaved down, and then an open roof, flat top nasal deformity is created. Therefore osteotomy’s are mandatory to close the open roof created from the hump removal itself. You also require spreader grafts to prevent the mid vault cartilages for collapsing inwards. A closed rhinoplasty approach can accomplish your goals with all the incisions placed on the inside of the nose. Rhinoplasty is the most difficult operation to perform correctly in the entire field of cosmetic surgery, so choose your surgeon very wisely based on extensive experience. Study your prospective surgeon’s before and after rhinoplasty photo Gallery, and make sure it is extensive.

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Plastic Surgery Center

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