The Seattle

Plastic Surgery Center

William A. Portuese, M.D.

Facial Plastic Surgery Questions and Answers: Part 8

Question: What are my options with a revision rhinoplasty, could I narrow my bridge?
Answer: A Closed revision rhinoplasty can accomplish narrowing and straightening your nasal bones with osteotomies to try to help with the inverted V deformity. In addition to osteotomies, we usually place spreader grafts, composed of the patient’s own cartilage underneath the upper lateral cartilage in the mid vault of the nose, which also helps to widen those cartilages to match the nasal bones. It’s important to know if you have any further cartilage left over on the inside of your nose, and whether or not, you’ve had spreader graphs in the past. You also have a small residual dorsal hump, which can be filed down as well.

Question: Can the hump on my nose bridge be removed without needing any other adjustments or will it make my nose appear bigger?
Answer: If you only remove the hump, you will be left with a flat top, open roof and excessively wide bridge line, which will be out of balance. You will need a full rhinoplasty, which includes hump removal, osteotomies placed in the nasal bones, refinement of the nasal tip, and placement of spreader grafts in the mid portion of the nose to prevent collapse of the upper lateral cartilages after the hump removal itself. Since rhinoplasty is the most difficult operation to perform correctly in the entire field of cosmetic surgery, choose your plastic surgeon wisely based on extensive experience producing natural results.

Question: I’m getting chin lipo and a chin implant and would like to know if I should also get buccal fat removal?
Answer: More information is needed such as photographs from all angles, your height, weight, and BMI to make a determination about three surgical procedures. The Limited photograph from the side profile demonstrates recessive chin for which a chin implant can improve. You also have significant fat deposits above AND below the platysma muscle which will require a necklift to remove both fat deposits. Liposuction can only accomplish removal of fat deposits above the muscle, and it will be an incomplete result. No skin removal is required.

Question: Would love to see if an outpatient columelloplasty is reasonable and not greedy?
Answer: A full set of pictures from all angles are required, since revision rhinoplasty is more difficult than a primary rhinoplasty. Trimming excess skin and Cartlidge can be accomplished under a brief general anesthesia as an outpatient procedure.

Question: Chin implant or jaw surgery for recessed chin and a narrow palate?
Answer: Placement of a chin implant is done for cosmetic purposes, while jaw surgery is done to realign the teeth. If your teeth are significantly out of alignment, then consider jaw surgery. Placement of a chin implant is performed under local anesthesia with which takes approximately 30 minutes and is much less invasive. Jaw surgery is performed by an oral surgeon under general anesthesia in a hospital setting with an overnight stay at the hospital and is much more invasive.

Question: Is chin lipo necessary to define my chin?
Answer: There appears to be a small amount of fat in the neck which can be removed with liposuction. There also appears to be a recessive Chin profile for which a chin implant can augment the chin forward for better facial balance and proportions, especially with respect to the projection of the nose from the side profile.

Question: Is filler a good option or would I eventually have to get a revision?
Answer: No, fillers are not a good option for this issue. The soft tissue triangles are indented in addition to alar retraction, therefore the composite skin/ cartilage graft we’ll be required to permanently improve this area.

Question: Can my hanging columella be corrected under local anesthesia?
Answer: Performing a columella-plasty can be performed under local anesthesia, but will be very painful and uncomfortable try to get this area completely numb For the surgery. Excess skin, cartilage, and bony nasal spinal need to be reduced in this area. Performing a columella plasty will probably decrease the overall projection of the nose and make your hump look larger. Probably best to undergo a full rhinoplasty under general anesthesia to ensure all the components of the nose are completely balanced.

Question: What can I do to refresh my eyes and look more awake?
Answer: A full set of facial and eyelid photographs are going to be required to make a determination about how best to proceed. Those photographs need to be when you’re not smiling. The primary goal for upper eyelid surgery is to remove extra skin and a little bit of fat, while the primary goal for lower eyelid surgery is to remove fat bags.

Question: Imaging the day before surgery?
Answer: In our practice, we perform computer imaging as an integral part of the consultation process several months Before the surgery itself, so that patients have time to review the imaging results well before the surgery Itself. Imaging imaging results are discussed at The time of the examination and consultation.

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