Facial Plastic Surgery Questions and Answers: Part 01

Question: Do I have to dissolve filler in my nose before rhinoplasty?
Answer: Placement of filler in the nose distorts the anatomy of the nose itself, so it’s best to dissolve the filler several weeks ahead of time. Rhinoplasty is a procedure that is performed in millimeters, so it’s best to go in to the procedure with your normal anatomy, not an artificial anatomy.

Question: Why don’t doctors recommend a cheek or mid face lift?
Answer: It’s because the Face does not descend vertically with the aging process, like the lateral face does. The mid face shrinks with volume loss, therefore we place cheek implants in the cheeks to restore that lost volume. There are many different complications can occur with a midface lift, that’s why we never recommend them.

Question: Recessive chin and fat cheeks – SMAS face/necklift and/or genioplasty?
Answer: Even though you’ve had a chin implant, you still have a recessive chin, so consider placement of a larger chin implant. You also have significant fat deposits in your neck, located both above and below the platysma muscle. You will also require a neck lift procedure to remove both fat compartments in the neck, in addition to a platysma – plasty. At age 35, your skin tone should be acceptable, and skin removal should not be required. You should also have a BMI of less than 32 before undergoing any of these facial and neck procedures.

Question: Badly botched 8 years ago. Is this fixable?
Answer: Much more information is needed, such as a full set of facial photographs of your nose from all angles, and even a copy of the operative report. The nose is a three-dimensional structure, and rhinoplasty is performed in all three dimensions. Revision rhinoplasty is more difficult than a primary rhinoplasty, so it’s imperative to have realistic expectations. It appears from the one very limited photograph that you had anosteotomy placed too high on the left nasal bone resulting in that line. Low lateral osteotomy’s should be able to improve your issue, but that will be determined at the time of a physical examination.

Question: Am I candidate for bleph or ptosis surgery? I’ve always been like that I’m 33.
Answer: The Photographs are rather limited, but it does appear that you have excess skin on the upper lids for which a cosmetic upper blepharoplasty can improve. There does not appear to be ptosis from these photographs, but that may need to be determined at the time of examination.

Question: If I suspect an untreated broken nose (10 years) is causing discomfort/breathing issues, what steps should I take?
Answer: Trauma to the nose can cause a variety of issues such as a displaced nasal fracture, a dislocation of the upper lateral cartilages, and a deviated septum. A septoplasty is performed to straighten a deviated septum on the inside of the nose to improve airflow. A rhinoplasty is considered cosmetic which can accomplish shaving down the dorsal hump, straightening the bridge line, and placement of spreader grafts underneath the concave upper lateral cartilages in the midportion of the nose. A closed rhinoplasty approach can accomplish all this with incisions completely placed on the inside of the nose. No external incisions are required.

Question: What treatment would be best to address double chin (Kybella, Smartlipo or VASER) yet not breaking the bank?
Answer: Its difficult to tell photographs, but you most likely have fat deposits located both above and below the platysma muscle. Liposuction can accomplish removal of fat deposits above the muscle, while a surgical neck lift with the platysma plasty is required to address that deposits below the platysma muscle. Kybella cannot remove the fat deposits below the muscle.

Question: What is causing my upper eyelids to be droopy? Would I need surgery or are there less invasive options?
Answer: The picture demonstrates excess skin on the upper eyelids known as dermatochalasis. The skin appears to be resting on your eyelashes, therefore you are great candidate for upper eyelid blepharoplasty. This procedure takes about 30 minutes and involves removing excess skin on the upper eyelids to rejuvenate them. The procedure can be performed under local anesthesia or general anesthesia.

Question: I was told a mini facelift combined with Profound would give me good results?
Answer: From the photographs presented, a lower face and neck lift is going to be required to tighten loose facial and neck skin, tighten loose facial and neck muscles, lift the jowls, and remove any fatty deposits of neck with liposuction. Minimally invasive devices will not accomplish any of these goals.

Question: Do I have an inverted v, open roof deformity, and polybeak from side? Do I need a revision with a graft?
Answer: Its very difficult to tell from the photographs, but you most likely have an open roof deformity and an inverted V deformity as well along with a poly-beak. The polybeak can be the result of excess cartilage or thick skin and scar tissue. Each 1 of those issues are treated differently. It is very important to know how much cartilage is left over on the inside of her nose for potential grafting purposes, since the inverted V deformity will require osteotomies and then spreader graft placement underneath the concave upper lateral cartilages in the mid portion of the nose.


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    Seattle Nose Surgeon ®
    William Portuese MD
    Joseph Shvidler MD

    Seattle, Washington 98104

    (206) 624-6200

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