Facial Plastic Surgery Questions and Answers: Part 02

Question: Why do some surgeons only offer general anesthesia for rhinoplasty & what are the advantages of each method?
Answer: Since rhinoplasty involves multiple different injections in the nose to get the nose numb prior to plastic surgery, and the fact that there are there is lots of nerve endings, it’s very difficult to get the nose even numbed up for the rhinoplasty procedure. Both medial and lateral osteotomies are placed in the nasal bones are also performed, and most patients don’t want have conscious awareness of procedure that maneuver bro of breaking the nasal bones during the rhinoplasty procedure. It’s also very important have a controlled airway so that you’re not aspirating blood down into the lungs if you’re sedated while you are not breathing on your own under sedation.

Question: Lower facelift in March 2023 – do I need a facelift revision?
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. A Copy of the operative report would also be helpful to find out what type of facelift you’ve had in the past. Also best to wait at least one year to allow for full healing before embarking on another procedure. It’s also important to understand that a facelift will not remove wrinkles around the mouth.

Question: Would a chin implant or genioplasty help improve the appearance of my jaw?
Answer: Placement of a chin implant can be performed under local anesthesia to cosmetically augment your chin mostly forward, but you will also get some lateral width as well. This procedure usually takes about 30 minutes, and will not affect the way your teeth fit together. A Genioplasty is performed by an oral surgeon when your teeth are significantly out of alignment.

Question: Should I consider neck lift after no result from Facetite and Morpheus8 (late 20s)?
Answer: The Photographs demonstrate a process of the chin profile, and fat deposits located both above and below the platysma muscle in the neck itself. Noninvasive procedures simply will not help with these issues. Consider placement of a chin implant to augment the chin forward. A neck lift procedure involves removal of fat above the muscle with liposuction, and surgical extraction of the fat below the muscle along with a platysma-plasty. Also best make sure that your BMI is less than 30 before undergoing this procedure.

Question: Would I be wasting a surgeon’s time trying to see if insurance would cover a blepharoplasty?
Answer: Medical Insurance companies admitting very difficult to get reimbursed for this procedure any longer. A skin only upper blepharoplasty can be performed under local anesthesia to help reduce costs.

Question: Would dermal fillers or a facelift be the right choice to get rid of sagging jowls?
Answer: More information is needed such as a full set of facial and neck photographs from all angles to make a determination about being a candidate for a facelift procedure. The goal of the lower face and neck lift is to tighten loose facial and neck skin, tighten loose facial and neck muscles, lift the jowls, and remove the fat deposits in the neck with liposuction which also includes a platysma-plasty. Fillers are very temporary and can offer some augmentation in certain areas that are soft tissue deficient. Temporary Fillers are not substitute for a face and neck lift surgical procedure.

Question: What would you suggest for my double chin and jowls (5’6 and 135lbs)?
Answer: The Photographs demonstrate a recessive chin profile and fat deposits located above AND below the platysma muscle in the neck. Consider placement of a small chin implant to augment the chin forward for better facial balance and proportions. A neck lift procedure can accomplish fat removal in the neck with liposuction above the platysma muscle and surgical removal of the fat below the muscle which also includes a platysma-plasty to significantly improve the jawline once the fat has been removed from the neck itself.

Question: Late 30s – can I have a third or will my nose be even worse?
Answer: There’s definitely some improvement that can be made regarding your nose, but it’s imperative to choose a rhinoplasty specialist based on extensive experience. Your nose will never be perfect, just improvements. A full set of facial photographs from all angles would also be helpful to understand your current anatomy. You appear to have alar retraction on your left nostril which requires a composite graft from the ear to improve.

Question: Rhinoplasty, Septoplasty and Turbinate reduction
Answer: A closed rhinoplasty approach can accomplish making the entire nose smaller which includes shaving down the dorsal hump, decreasing the projection, refining the nasal tip, and narrow bridge line with all of the incisions placed on the inside of the nose. Septoplasty and turbinate reduction are performed internally for breathing difficulties. Digital computer imaging of your nose upon your facial features would be helpful to understand what can be accomplished with a closed rhinoplasty.

Question: 50 years old female, is the 5 layer neck lift something new or not commonly done? 
Answer: We have never heard of a five layer necklift. A full set of facial photographs from all angles are required to make a determination about the proper procedure for you. At age 50, you’re probably a candidate for a lower face and neck lift which accomplishes tightening lose facial and neck skin, tightening a loose facial and neck muscles, lifting the jowls, and removing the fat deposits in the neck itself which are located both above and below the platysma muscle. This also includes a platysma plasty to significantly improve the jawline.


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    The Seattle Rhinoplasty Center

    Seattle Nose Surgeon ®
    William Portuese MD
    Joseph Shvidler MD

    Seattle, Washington 98104

    (206) 624-6200

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