The Seattle

Plastic Surgery Center

William A. Portuese, M.D.

Facial Plastic Surgery Questions and Answers: Part 10

Question: Which procedure would help minimize the appearance of under eye bags while delivering a more youthful appearance?
Answer: A trans conjunctival approach lower blepharoplasty can accomplish removal of the herniated fat compartments your lower lids to rejuvenate them. The Incision is located on the inside of the eyelids, no external incision is required unless there’s lots of loose skin present. The procedure is performed under a brief general anesthesia as an outpatient procedure.

Question:  Problematic healing after rhinoplasty. Is tip plasty an option?
Answer: Your bulbous tip maybe related to thick skin, which cannot be changed with a rhinoplasty procedure. You appear to still have a dorsal hump which is composed of both bone and cartilage. A Surgical revision rhinoplasty can be entertained, only after waiting a year from the last procedure.

Question: Is this revision goal to shave down the supratip a tiny amount realistic?
Answer: Yes indeed, your photo edits do look realistic, especially since steroid shots have not accomplished your goals. There’s probably residual cartilage left over in the bridge which can be shaved down.

Question: Which procedure would deliver the best results for targeting the jowls? Previously had a mini facelift and Restylane 
Answer: The photographs are very limited, but based on these photographs you could consider placement of a pre-jowl implant to augment the significant pre-Jowl sulcus that you have presently. This will build out the area just in front of the Jowls. A lower face will be required not only lift the jowls, but tighten loose facial and neck skin, tight tight loose loose facial and neck muscles,and remove fat deposits in the neck.

Question: Upper blepharoplasty or brow lift?
Answer: From the photos presented, your eyebrow position is acceptable, so a brow lift would just make you look too surprised permanently. You also have more hooded skin on your right eyelid, and during the upper blepharoplasty procedure a differential amount of skin is removed to make them look more symmetrical. In our practice, we perform upper blepharoplasty under local anesthesia which takes about 30 minutes in our surgery center.

Question: What surgical procedure would be recommended for my sagging neck (Age: 30)?
Answer: You have Fat deposits located underneath the platysma muscle in your neck, which must be removed with a surgical necklift which also includes a platysma-plasty to significantly improve the jawline. Liposuction won’t be effective because it only removes the fat deposits above the muscle. This procedure i performed under general anesthesia with three small access incisions located underneath the Chin and behind the ears. No skin removal is required.

Question:  Are Kenolog shots common after rhinoplasty? 
Answer: In our practice it’s very common to perform multiple kenalog shots for patients since we have a large ethnic rhinoplasty base with thick skin. We also perform closed rhinoplasty which causes less swelling than open rhinoplasty which is more invasive.

Question: Who should I see to address asymmetry of the facial bones?
Answer: It is very normal to have facial asymmetry, and everyone has some degree of it. This is because there is a left half of the face and a right half of the face that come together in the embryo phase. They are never exactly equal. If the left cheekbone is less projecting than the right cheek bone, then consider placement of a cheek implant to augment the left side to look more similar to the right side. A rhinoplasty procedure can accomplish straightening the nose, shaving down the dorsal hump, and making other adjustments to make the nose to make it look more symmetrical.

Question: Cheek Implant sensation in face?
Answer: Cheek implants are placed well below the facial muscles, and are placed directly over the bone and underneath the periosteum. They are placed through intraoral incision under general anesthesia as an outpatient procedure. Since the implant is a bony augmentation, you will not be feel any pressure in your face when you smile.

Question: Should I proceed with revision surgery to file down a dent?
Answer: When performing a revision Rhinoplasty, it’s important to file down a bump, however dents are treated with additional cartilage graft added to that area. It is important to know how much cartilage is left over on the inside of your nose for grafting purposes. Revision rhinoplasty is one of the most difficult procedures to perform correctly in the entire field of cosmetic surgery, so it’s important to know much more information including copies of the operative reports and a full set of facial photographs from all angles in addition to an in-person examination.

The Seattle

Plastic Surgery Center


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