The Seattle

Plastic Surgery Center

William A. Portuese, M.D.

Facial Plastic Surgery Questions and Answers: Part 9

Question: Can I keep my same structure of nose bridge and get a nose bridge hump removed?
Answer: A closed rhinoplasty approach can accomplish reduction of the bulbous tip, shaving down the dorsal hump, and narrowing the bridge line with all of the incisions placed on the inside of the nose. No external incisions are required and no painful packing is required either. Rhinoplasty is a very difficult endeavor, so choose your plastic surgeon wisely based on extensive experience. Study your perspective surgeon’s before and after rhinoplasty photo gallery, which should be extensive.

Question: Revision Rhino Advise – How to select the right surgeon when their opinions contradict each other?
Answer: Open versus Closed Rhinoplasty is only about the approach on how you get into the nose, not the maneuvers that are performed inside of the nose itself. You have a residual dorsal hump, which needs to be shaved down, a droopy and wide nasal tip and an inverted upper lateral cartilage on your left side, which will definitely require a spreader graft. It’s important to know if there’s any cartilage left over on the inside of your nose for grafting purposes. If not, a Cartilage graft, may be needed to be harvested from your ear. Osteotomies also be required to close the open roof, which occurs when the hump removal takes place. For over 30 years, we have only performed closed rhinoplasty.

Question: Is this a tension nose with hanging columella?
Answer: You have a dorsal hump, a tension, nose, and hanging columella. A closed rhinoplasty approach can accomplish improving all of these issues. No external incisions are required and no painful packing is required either. This procedure is performed under a one hour general anesthesia, monitored by a board-certified physician anesthesiologist. Choose your rhinoplasty specialist very wisely based on extensive experience reducing the hanging columella with a closed approach. Study your perspective surgeon’s before and after rhinoplasty photo gallery.

Question: What treatment will smooth these wrinkles please?
Answer: The only treatment it will help with loose And inelastic skin in the neck is going to be a lower face and neck lift procedure.

Question: I’m wondering how much might be covered by insurance should I choose to get it fixed?
Answer: A deviated septum causes nasal obstruction. Fixing a deviate septum is not going to straighten a crooked nose, a cosmetic rhinoplasty is required for that. A cartilage craft can be used to build up the concavity in the nose for a collapse. Insurance is only billed once medical necessity has been determined, and then preauthorization has occurred with your medical insurance. Anticipate co-pays and deductibles associated with your insurance. Changing the shape of the nose is cosmetic, and must be paid for by the patient.

Question: Can chin liposuction be performed while breast feeding?
Answer: The simple answer is yes, you can undergo chin liposuction while breast-feeding. Much more information is needed, such as your height, weight, and a full set of facial photographs, including your neck to make a determination about whether you are a candidate for the procedure. It’s also important to be at your ideal body weight. It’s also important to know that there are two compartments of fat in the neck which are located both above and below the platysma muscle in your neck. Liposuction can only accomplish removal of the fat deposits above the muscle, while a surgical neck lift with a platysma plasty is performed when there’s fat deposits below the muscle.

Question: Over Projected Tip, Over Reduced Bridge?
Answer: From the one limited side profile, it appears that you do have an over projected tip, but you also have a mildly under projected mandible and chin projection. Consider placement of a very small chin implant to augment your chin forward for better facial balance and proportions, especially with respect to the projection of your nose. Adding additional projection to your Chen will help make your nose look less projecting. Best to leave your nose alone, since it’s fairly well balanced other than the projection of it itself, and you can get into all kinds of other three-dimensional healing issues.

Question: Least invasive neck lift? Is the potential for nerve damage any less? 
Answer: A full set of facial and neck photographs are required to make a determination if your candidate for neck lift procedure. It’s also important understand that there are two compartments a fat in the neck, and they’re located both above and below the platysma muscle. Liposuction can only accomplish removal of the fat deposits above the muscle, while a surgical neck lift is required to remove fat deposits located below the muscle. A corset platysma plasty is also performed if there’s been fat removal below the muscle. No skin removal is performed.

Question: Does lateral brow lift typically carry less risk of nerve injury since it is less invasive?
Answer: A lateral brow lift does have less risk of nerve injury, but also accomplishes much less lift because it is minimally invasive. It Cannot address forehead lines. A traditional coronal forehead lift can address lifting the entire forehead, making the eyebrows more symmetrical, softening the corrugator and frontalis muscles creating the vertical and horizontal lines in the fore head, and adjusting the hairline upwards or downwards.

Question: My nose was broken, can following results be achieved?
Answer: A closed rhinoplasty approached can accomplish Straightening and narrowing your bridge line and refining the nasal tip with all the incisions placed on the inside of the nose. No external incisions are required,and no painful packing is required either. Also important to know if there’s any cartilage left over on the inside of your nose, and if you have a deviated septum.

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